Introduction

Point-of-care decision-making tools are syntheses of evidence whose goal is to make physicians' decision-making easier. The value of synthesized evidence to health professionals working at the frontlines of care has been demonstrated in numerous studies, but they are particularly useful in searching for answers to clinical questions via medical databases. Being short of time, clinicians typically browseGoogle scholar, PubMed and other search tools to find needed information. But when a POC tool or appraised source of information is available, they have the effect of freeing health professionals from having to locate medical evidence for themselves.

Most health providers are accustomed to reading digested, summaries of evidence to guide them in their clinical thinking and decision-making. Point-of-care tools help in that regard. The point-of-care sources below aim to synthesize all available evidence for major clinical topics (especially the top layers of the evidence-based pyramid). By summarizing medical knowledge, it is easier to apply the best evidence within the context of providing patient care.

Access and navigation issues

Point-of-care decision-making tools make health professionals' synthesis of evidence easier. However, many of these tools are accessed by keyword or textword searches (ie. no MeSH) relying on point-and-click findability, browsing and scanning of web pages to find what is needed. That said, some POC tools are easier to navigate than others due to the use of structured abstracts and well-designed interfaces. Keep in mind that POC tools tend to answer very broad clinical questions and are not as helpful for specific foreground questions. Point-of-care tools are small in size compared to the many million citations in MEDLINE and EMBASE; and tiny compared to the mammoth Web or Google scholar. In addition, as proprietary tools, they are owned by commercial vendors and are generally marketed as tools that synthesize medical evidence from the major medical databases.

Background vs. foreground clinical questions

Some health librarians view point-of-care tools as tertiary synthesized sources of information ie. syntheses of primary and secondary research articles, and evidence, from major biomedical journals. An example of a primary research article is a recently published clinical trial of a drug indexed in MEDLINE; an example of secondary research is a review of recent clinical trials in a specific area of medicine. Seesystematic review, for examples. Finding answers to clinical questions may require searches for general, background information about the who, what, where, when or why about a disease, or its processes. Examples of background questions include What is Down's syndrome? and What is trisomy 21? Background questions are simple questions about the facts of a disease, and some point-of-care tools provide excellent context (or background) for these questions. Two tools strong in providing background are UpToDate and BMJ Clinical Evidence. Guyatt et al suggest that background questions are most often asked by medical students. As medical training continues through residency and practice, clinical questions get more and more specific - the foreground of medical evidence. Many research studies indexed in MEDLINE answer specific foreground questions whereas textbooks answer background questions.

ACP Journal Club – OvidSP

ACP Journal Club - http://www.acpjc.org/ comprises an archive (from 2000 to the present) of the cumulative electronic contents of ACP Journal Club, with recurrent weeding of out-of-date articles. The content is carefully selected from over 100 clinical journals through reliable application of explicit criteria for scientific merit, followed by assessment of relevance to medical practice by clinical specialists. Its general purpose is to select from the biomedical literature articles that report original studies and systematic reviews that warrant immediate attention by physicians attempting to keep pace with important advances in internal medicine. These articles are summarized in value-added abstracts and commented on by clinical experts. ACP Journal Club is available via OVID EBM Reviews. ACP has developed a PLUS version that provides access to all articles that pass the ACP Journal Club criteria.

BMJ Clinical Evidence

BMJ Clinical Evidence uses the evidence from systematic reviews to address clinical questions such as what is effective in treating common cold? It is an international source of the best available evidence for effective health care. Using a large team of experienced information specialists, editors, peer reviewers, and expert authors, Clinical Evidence selects around 3000 treatments that have been evaluated in research for analysis and divides their effectiveness for specific indications into categories. CE is based on questions that clinicians and patients want answered. This may be the right starting place for a search for relevant evidence on major topics.

BMJ "Best Practice"

BMJ Best Practice provides medical professionals with the best available information for just about any clinical situation. Regularly updated, it draws on the latest evidence to offer step-by-step guidance on diagnosis, prognosis, treatment and prevention. BMJ Best Practice is your instant second opinion.

Unrivalled breadth and depth of coverage helping healthcare professionals make decisions with confidence

Continuously updated with multiple changes to topics each day to reflect the best available evidence

Standardised navigation structure for each condition including summary and definition, aetiology, epidemiology, through key diagnostic steps and tests into treatment approaches with drugs, guidelines and evidence, finishing with recommendations and outlook for patient follow-up

ClinicalAccess by McGraw Hill

ClinicalAccess by McGraw Hill is the first clinical decision support tool that provides health professionals with accurate answers to physician-answered questions – enabling busy healthcare professionals to deliver superior care with maximum speed and efficiency. Its byline is: "...targeted, hand-selected answers to questions encountered at the point of care..."

Clinical Evidence (see BMJ Clinical Evidence)

ClinicalKey by Elsevier

ClinicalKey is a medical search engine and database tool owned by medical and scientific publishing company Elsevier that offers access to the extensive medical library of resources. Users are given full access to 500 of Elsevier's journals, 900 books and 9,000 medical videos. The system provides links to reviews by subject experts from First Consult, and they are given tags known as "smart content" using Elsevier's Merged Medical Taxonomy. Filtering tools are provided for journals, textbooks, clinical guidelines, clinical trials, First Consult reviews, images and to PubMed. Users can export citations, images and copyright information into PowerPoint presentations,

In 2013, Elsevier said that ClinicalKey would replace MD Consult & FirstConsult. Early reviews suggested that these tools while useful were not the best way into clinical content. UpToDate, for its part, is written in an order and language that clinicians like and provides good clinical summaries. Other than medical students, few clinicians seem to use MDConsult; however, even they do not have the time needed to wade though a monolithic website or trying to figure out how to get the one piece of information they need. If it's not in UpToDate or PubMed, they give up or ask a health librarian.

Clinical pharmacology – Elsevier

Clinical pharmacology is used by more than 1,500 hospitals and over 35,000 retail pharmacies in the U.S., as well as government and managed care agencies, PBMs, pharmaceutical manufacturers and academic institutions. Provides up-to-date, peer-reviewed, clinically-relevant point-of-care drug information for all U.S. prescription drugs, as well as off-label uses and dosage, herbal supplements, nutritional and over-the-counter products and new or investigational drugs.

CliniPearls – UBC eHealth Strategy

CliniPEARLS is a PDA software to provide up-to-date Clinical Practice Guidelines (CPG). The streamlined user interface allows practitioners to easily find the information they need at the Point-of-Care. At present there are more than 5000 registered physicians and other health professionals using CliniPearls. The software currently provides access to 38 guidelines.

Cochrane Database of Systematic Reviews

Since 1996, systematic reviews prepared and maintained by the Cochrane Collaboration have been published in The Cochrane Database of Systematic Reviews. CDSRs are regularly updated as more information becomes available and in response to comments from physicians. Systematic reviews are now widely regarded as being of better quality, on average, than their counterparts in print journals.

Cochrane Database of Systematic Reviews is one of the most important databases in evidence-based medicine. It is on par with MEDLINE in the view of many and provides quick access to the systematic reviews of randomized controlled trials (RCTs) undertaken by the international Cochrane Collaboration. Its strength is providing easy access to RCTs that deal with drugs, interventions and therapies. For more information, see Cochrane Library.

Database of Abstracts of Reviews of Effects (DARE) – OvidSP or Wiley

DARE is the only database to contain abstracts of systematic reviews that have been quality assessed. Each abstract includes a summary of the review together with a critical commentary about the overall quality. The database is a key resource for busy decision makers and can be used for answering questions about the effects of specific interventions, whether such questions arise from practice or when making policy. DARE covers a broad range of health related interventions and includes over 3000 abstracts of reviews in fields as diverse as diagnostic tests, public health, health promotion, pharmacology, surgery, psychology and the organization and delivery of healthcare. DARE complements the Cochrane Database of Systematic Reviews by quality-assessing and summarizing reviews that have not yet been completed by the Cochrane Collaboration. DARE is produced by the Centre for Reviews and Dissemination (CRD), University of York, UK and undertakes weekly extensive searches and assesses thousands of citations to identify potential systematic reviews.

DynaMed Plus

DynaMed Plus is a just-in-time reference tool integrating evidence-based and practical information for clinical practice. As a point-­of-­care tool, it is easy to use and offers clinically organized summaries to more than 3200 topics and covers more than 500 journals. Content is updated daily. DynaMed does not offer all evidence on topics but rather the best evidence. Summaries are listed alphabetically and by category and are searchable. DynaMed also offers handy calculators, decision trees, clinical criteria, and unit and dose converters. Lexi-Comp can be integrated as a separate service. An article by Banzi et al in the British Medical Journal has found Dynamed to be the most up-to-date point of care tool available. For more information, see DynaMed Plus...

Evidence-Based Medicine Guidelines (EBMG) – Wiley

Evidence-Based Medicine Guidelines (EBMG) by Wiley publishers provides physicians with access to 1,000 concise, evidence-based summaries of symptoms and diseases, over 3,000 high quality evidence summaries and a library of 1,000 photographs and images. Developed by ~300 general practitioners and specialists, it includes diagnostic and therapeutic guidelines and recommendations on diagnostic tests and drug dosage. Information is presented in a user-friendly format with clear explanations of all available evidence. Evidence is graded from A to D and assumes no prior statistical knowledge. Protocols are transformed into images and decision support tools.

eMedicine – WebMD

eMedicine comprises the largest and most current Clinical Knowledge Base available freely to physicians and other healthcare professionals. eMedicine's subscription site for point-of-care use for institutions is iMedicine. Nearly 10,000 physician authors and editors contribute to the eMedicine multimedia Clinical Knowledge Base, which contains articles on 7,000 diseases and disorders. The evidence-based content, updated regularly, provides the latest practice guidelines in 59 medical specialties. eMedicine's professional content undergoes 4 levels of physician peer review plus an additional review by a PharmD prior to publication.

Essential Evidence Plus – formerly 'InfoPOEMs/InfoRetriever'

Essential Evidence Plus, formerly 'InfoPOEMs/InfoRetriever', features over 13,000 topics, guidelines, abstracts, and summaries that cover the most common conditions, diseases, and procedures clinicians see regularly. EE+ brings information into practice by answering key clinical questions to help save lives and prevent suffering. EE+ is a comprehensive, evidence-based clinical decision support system trusted by health professionals. This clinical reference tool is created by a team of leading physicians and medical information experts; it was designed by physicians, nurses, and other health care professionals on the frontlines of patient care. All relevant medical literature is reviewed and evaluated for validity, and synthesized down to the Bottom Line essentials which clinicians need to make decisions in an instant; each recommendation carries a strength of evidence rating. EE+ will support you in making diagnoses, creating treatment plans, and determining prognoses for better clinical care. This clinical decision support system not only includes access to the Essential Evidence disease topics, but also instantly links out to other world-renowned evidence-based medicine resources, including the Cochrane Library and Evidence-Based Medicine Guidelines, in just one search.

Evidence Matters

Evidence Matters (EM) is a user-friendly clinical knowledge management system to help support the use of research in decision-making. It answers questions on the effectiveness, safety, and costs of therapy options for a particular patient, in an evidence-based manner. Designed by clinicians, users of EM include clinicians, decision-makers, managers, medical librarians, and those who create guidelines, careplans, and formularies. EM creates patient-customized answers via summarized, instant meta-analyses (more accurately a "meta-graph") of all current research and best practices from thousands of peer-reviewed journals. More...

Harrison's Practice – Answers on Demand

Harrison's Practice: Answers on Demand delivers essential point-of-care information on the diagnosis and management of over 800 medical conditions. Continuously updated and available for desktop and mobile devices. The tool is also a fully integrated drug database that includes dosing information, adverse reactions, indications and contraindications. Hyperlinks to PubMed provide instant access to primary literature; personalization features that include saving content to "My Archive" and your mobile device.

JBI COnNECT – Joanna Briggs Institute

JBI COnNECT (Clinical Online Network of Evidence for Care and Therapeutics) is an evidence-informed qualitative source of information for nurses, midwives, dieticians, physiotherapists, radiography technicians. It contains the Joanna Briggs Systematic Review Database, Best Practice Information Sheets, Protocols & Work in Progress, Healthcare Reports, COnNECT, a collection of evidence-based resources and tools and RAPid, the Rapid Appraisal Protocol Internet Database. JBIC develops pre-appraised evidence summaries and clinical pathways to assist patients/residents/clients, their families and those involved in their care, to use evidence-based information in clinical decision-making. JBIC assigns a level of evidence to systematic reviews in the database.

Some librarians feel that the coverage on JBI is limited for North American practitioners beyond nursing. When information is available it's thorough. If your searches are focused on a topic with less coverage, e.g. cancer/oncology, JBI content may not be worth the fee. If your systematic searches are focussed on nursing or allied health, it's important to check JBI to see whether the topic has been covered. Those with access say "Best Practices" and "Recommended Practices" are useful sections though not of the high quality in JBI systematic reviews. Many nurses ask for JBI content when formulating policies and procedures. JBI is also considered to be a major resource for evidence-based practice in Australian nursing schools.

Some librarians report poor searchability on JBI. Some reported lax indexing and poor standardization of data entry making even author searches problematic. "You might as well search Google!" The lack of standardization in data entry apparently causes problems with exports to bibliographic management programs (EndNote, RefWorks, etc.) also. One respondent said her library licenses JBI's journal and it gets used...

Joanna Briggs Institute EBP Database on OVID

Joanna Briggs Institute EBP Database is published by the Joanna Briggs Institute (JBI) (seehandout by Ovid). The Institute is widely regarded as one of the world’s leading providers of evidence–based information from across the globe, as well as the tools that help healthcare professionals implement an effective evidence–based practice program and provide the best possible patient care. JBI and its collaborating entities, which are based at the University of Adelaide, South Australia, promote and support the synthesis, transfer and utilization of evidence through identifying feasible, appropriate, meaningful and effective healthcare practices to assist in the improvement of healthcare outcomes globally.

The Joanna Briggs Institute’s Evidence Based Practice database of systematic reviews complements those found in the Cochrane Library. The Joanna Briggs Institute, an international not-for-profit research and development organization, “develops evidence in various formats for nursing, allied health and medical professionals as well as support information for consumers.” It was established in Adelaide, South Australia in 1996, and collaborates internationally with over 70 entities world-wide.

What is included in the Joanna Briggs Institute EBP Database:

3,000 records across seven publication types:

Evidence Summaries — Literature reviews that summarize existing international literature on common healthcare interventions and activities

Lippincott Advisor on Ovid

Lexicomp - Clinical Drug Information

Lexicomp Online provides clinicians access to two drug information resources within a single interface: 1) Lexicomp - clear, concise, point-of-care drug information, including dosing, administration, warnings and precautions, as well as clinical content, such as clinical practice guidelines, IV compatibility from Trissel's 2 Clinical Pharmaceutics Database, and other tools and 2) AHFS - extensive research solution, recognized as a CMS compendium to assist in reimbursement.

NHS Clinical Knowledge Summaries

The National Health Service website provides access to "reliable sources of evidence-based information and practical ‘know-how’ about common conditions managed in primary care. CKS provides quick answers to real-life questions that arise in the consultation, linking to detailed answers that clearly outline the evidence on which they are based”. Searchable by topic or alphabetically or by clinical topic, includes patient information, drug data, links to Cochrane and Dynamed. ‘My CKS’ allows storage of CKS content and web links. Simple, easy-to-use interface. NOTE: CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). It is still possible to browse information within the tool but please note that as of 2012 content is no longer being maintained.

University of California Press and partners in technology, healthcare, publishing, libraries, and open access are exploring the 2016 launch of an open access Point-of-Care Summaries tool called Open Library of Medicine.

With OvidMD™ get the right clinical answer quickly; uncover treatment options, evidence-based guidelines, and drug therapies, download images and patient handouts, link instantly to full text, and more – all in one search.

PEMSoft

PEMSoft is a worldwide pediatrics medical reference system, online clinical library and multimedia decision support system that addresses acute and chronic illness and injury conditions in children from newborn to young adult. Founded in 2003 by Drs. Robert Pitt and Ron Dieckmann, PEMSoft has highly linked and searchable information which is updated by a team of over fifty editors and hundreds of contributors...

PEPID – medical information resources

PEPID www.pepidonline.com is a "...comprehensive point-of-care and evidence-based reference tool that provides the latest practice recommendations, which are integrated directly into relevant clinical conditions, disease profiles and drug monographs..."

Professor EBM

Professor EBM is an online, evidence-based teaching resource for inpatient internal medicine. Composed of over 90 teaching modules it is designed for use in internal medicine residency programs and student clerkships. Each topic is researched, footnoted and updated annually. Influential studies are identified, summarized and analyzed. In diseases where evidence is sparse, relevant review articles, guidelines and systematic reviews are noted. All cases, questions, answers and summaries of original articles are developed using the principles of evidence-based medicine. The teaching modules are piloted in a real-life internal medicine residency program, and improvements are made based upon formal feedback from attendings and housestaff. The modules are designed to be taught in a small group, interactive format.

ProQuest Nursing & Allied Health Source

ProQuest Nursing & Allied Health Source provides users with reliable health information in nursing, allied health, alternative and complementary medicine and more. It is designed to meet the needs of researchers in health as well as nursing and allied programs at academic institutions. ProQuest Nursing & Allied Health Source provides abstracting and indexing for more than 1,015 titles, with over 860 titles in full-text, plus more than 12,300 fulltext dissertations representing the most rigorous scholarship in nursing and related fields.

Rehabilitation Reference Centre – EBSCO

Rehabilitation Reference Center™ (RRC) is an evidence-based clinical reference tool for use by rehabilitation clinicians at the point-of-care. RRC provides therapists and students with the best available evidence for their information needs in the areas of physical therapy, occupational therapy, speech therapy, etc. Content in RRC includes more than 450 Clinical Reviews, more than 150 research instruments, information from AHFS on over 11,700 drugs and their manufacturers, more than 9,800 exercise images, key reference handbooks, guidelines from the National Guideline Clearinghouse, more than 1,500 relevant patient education topics.

Swets Decision Support in Medicine

"...Decision Support in Medicine was founded by Lewis Reines, previously CEO of Saunders, Mosby, Churchill Livingstone Inc., and Lippincott during his 44 year print-publishing career. He became convinced that what was really wanted and needed by physicians was a true point-of-care series of programs, not one general program lacking any depth of coverage (and either a print text ported to a digital platform or a digital textbook that takes your patrons far too long to use at the point-of-care). This was echoed by librarians he talked to over the course of his career, which started at age 13 working in a medical bookshop. Thus, DSM was founded, and Mr. Reines tapped some of the leading names in their specialties to direct the editorial coverage."

Thomson Clinical Xpert

Thomson Clinical Xpert™ powers your handheld device with a wealth of clinical knowledge from Thomson Healthcare, the industry’s leading provider of evidence-based decision support. It is available for download to the including the iPhone, iPod touch, and iPad, as well as Windows Mobile, Palm and BlackBerry smartphones. It is updated instantly at each sync with the latest information and your downloads give you access to: disease and laboratory test information.

UpToDate – WoltersKluwer

UpToDate (seeUTD mobile) is a very popular POC tool that offers comprehensive "evidence-based clinical information" via the web, desktop or mobile device. It is written for a wide range of health professionals, but is targeted to internal medicine and related specialists. In 2012, UTD said that it would begin to create entries for psychiatry. Designed to provide concise, practical answers (almost recommendations with lists of evidence grades), the topics (~8,500) in UTD are written exclusively for clinicians in 17 different medical specialties. UTD has an extensive peer review process to ensure that recommendations are accurate and reliable. While considered an electronic book by health librarians, UTD is described as a "practical clinical reference tool designed to provide quick access to synthesized medical information in an easy-to-use format". It is comprised of topic reviews written by recognized experts who address specific topics, synthesize research and make recommendations for treatment. In total, UTD includes more than 97,000 pages of text, plus graphics, links to Medline abstracts, more than 385,000 references and a drug database. To write entries, 460 medical journals are searched regularly along with the biomedical databases and hand-searching of the literature.

ZynxEvidence

ZynxEvidence website is an online resource that provides evidence-based clinical content and best practice guidance for physicians, nurses, and allied health professionals in the hospital setting. Content is divided into more than 145 modules that address clinical conditions, procedures, and patient problems.